Comparison between different kernel reformatting filters in 3D quantitative analysis of MDCT coronary angiography

Background: Quantitative analysis of stenosis lesions by Computed Tomography angiography (CTA) show good correlation with Invasive Coronary Angiography (ICA) examination. However, detailed precision whether CTA overestimate or underestimate have not been explored thoroughly. Objectives: This research is performed to analyze the precision of CTA compared to ICA. Materials & Methods: There are 195 patients examined by both CTA and ICA from October 2014 until December 2015 in our hospital. CTA was analyzed by a team of cardiovascular imaging cardiologists. Quantitative grading of stenosis was determined visually using 2014 Society of Cardiovascular Computed Tomography (SCCT) guidelines classification. Quantitative measurement of stenosis during ICA was classified with the same criteria so that it can be comparable. The final comparison of both tests was classified as concordance, overestimate and underestimate. Results: Lesion of stenosis was found in 573 coronary vessels. Coronary vessels are significantly associated with detailed precision of quantitative analysis comparison in CTA and ICA. LM coronary stenosis quantification from CTA is predominantly overestimate (concordance in 6% vessels and overestimate in 75.9% vessels), while stenosis analysis by CTA in other major coronary vessels is spread without conspicuous domination (p<0.001). Sensitivity, specificity, PPV, and NPV of CTA to detect obstructive lesion (stenosis ≥ 50%) found by ICA is 81.4%, 80.4%, 73.9%, and 86.3%, respectively (780 vessels). Conclusions: Degree of stenosis in LM is predominantly overestimate by CTA. The precision of stenosis grading in CTA in different coronary vessels is not the same. Abstrak Latar Belakang: Analisis kuantitatif lesi stenosis pada pembuluh koroner menggunakan modalitas Computed Tomography Angiography (CTA) memiliki korelasi yang baik dengan pemeriksaan Invasive Coronary Angiography (ICA). Namun, presisi CTA terhadap ICA masih belum tereksplorasi dengan baik. Terutama dari sisi apakah CTA menunjukkan presisi yang overestimate atau underestimate. Tujuan: Penelitian ini dilakukan untuk menganalisis presisi CTA terhadap ICA dalam mendeteksi lesi stenosis pada pembuluh koroner. Metode Penelitian: Terdapat 195 pasien yang diperiksa menggunakan CTA dan ICA sejak Oktober 2014 hingga Desember 2015 di RS Jantung dan Pembuluh Darah Harapan Kita, Jakarta. Analisis kuantitatif CTA dilakukan oleh tim kardiolog pencitraan kardiovaskular. Klasifikasi derajat stenosis ditentukan secara visual menggunakan pedoman dari Society of Cardiovascular Computed Tomography (SCCT) 2014. Analisis kuantitatif lesi stenosis dari pemeriksaan ICA diklasifikasikan menggunakan pedoman yang sama sehingga keduanya dapat diperbandingkan. Data hasil perbandingan kedua modalitas diklasifikasikan sebagai concordance, overestimate dan underestimate. Hasil Penelitian: Lesi stenosis ditemukan pada 573 pembuluh koroner. Pembuluh koroner yang berbeda secara signifikan berhubungan dengan perbandingan klasifikasi analisis semi-kuantitatif CTA dan ICA. Pembuluh koroner LM terutama menunjukkan lesi dengan kategori overestimate (75.9%). Sementara analisis stenosis pada pembuluh koroner lainnya tidak menunjukkan perbedaan yang mencolok (p < 0,001). Sensitivitas, spesifisitas, PPV, dan NPV CTA dalam mendeteksi lesi koroner obstruktif (stenosis ≥50%) terhadap ICA adalah sebesar 81.4%, 80.4%, 73.9%, dan 86.3% (780 pembuluh kroner). Kesimpulan: Analisis stenosis semi-kuantitatif pada LM terutama adalah overestimate berdasarkan pemeriksaan CTA. Presisi analisis perbandingan derajat stenosis CT angiografi pada setiap pembuluh koroner tidak sama.

Download Full-text

Abstract 2594: Coronary Multidetector Computed Tomography in the Prognostic Assessment of Patients with Equivocal or Mildly Abnormal Non-Invasive Cardiac Stress Tests

Circulation ◽

10.1161/circ.116.suppl_16.ii_574-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Clerio Azevedo ◽

Mariane Spotti ◽

Sabrina Bezerra ◽

Marcelo Hadlich ◽

Humberto Villacorta ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Coronary Angiography ◽

Confidence Interval ◽

Coronary Stenosis ◽

Atherosclerotic Plaques ◽

Stress Tests ◽

Cardiac Stress ◽

Non Invasive ◽

Mdct Coronary Angiography

Background: Patients with low or moderate pre-test probability of significant coronary artery disease (CAD) and equivocal or mildly abnormal non-invasive cardiac stress tests represent a frequent management challenge. Coronary multidetector computed tomography (MDCT) has been shown to have excellent diagnostic accuracy to exclude the presence of significant CAD. Methods: The study included 218 patients (mean age 59±12 years, 60% male) with equivocal or mildly abnormal exercise electrocardiography (n=93), stress SPECT perfusion scans (n=121), stress echocardiography (n=3) and stress cardiac MRI (n=1). Patients were either asymptomatic (n=113) or had atypical chest pain (n=105). All patients underwent contrast-enhanced 64-slice MDCT coronary angiography and datasets were evaluated for the presence of coronary atherosclerotic plaques and significant coronary artery stenosis. Patients were followed for 8±3 months and the endpoints evaluated were: cardiac death, myocardial infarction, revascularization procedure performed >3 months after MDCT coronary angiography and unstable angina requiring hospitalization. Results: MDCT coronary angiography was either normal (n=90; 41%), demonstrated non-obstructive coronary atherosclerotic plaques (n=66; 30%) or exhibited significant coronary stenosis (n=62; 29%). Event-free survival was 100% for patients with normal coronary angiography, 98% for patients with non-obstructive plaques and 92% for patients with coronary stenosis (log-rank test P=0.01). One patient with a non-obstructive plaque involving the left main coronary artery died following an AMI (hazard ratio, 0.38; 95% confidence interval, 0.04 to 3.24). Among patients with coronary stenosis, 3 underwent revascularization procedures and 2 died (hazard ratio, 12.59; 95% confidence interval, 1.47 to 107.86). Conclusion: Among patients with equivocal or mildly abnormal non-invasive cardiac stress tests, a normal MDCT coronary angiography is associated with a very low risk for subsequent cardiac events. Further studies are necessary to determine the clinical significance of non-obstructive atherosclerotic plaques detected by MDCT coronary angiography in this patient population.

Download Full-text